BURNS ALGORITHM

SSM PRESENTATION

Ammaarah Isaacs
ISCAMM002
MBChB III
22 Aug 2022
 METHODS

• Systematic review search on PubMed using the keywords 'burns', 'treatment', 'prehospital'
yielded 6 results of which 2 fit the inclusion criteria.
• Google Scholar keyword search for ‘fluid therapy in burns prehospital’ yielded 14800
results of which 1 fit the inclusion criteria
• Google Scholar free word search for ‘duration of cooling burns’ yielded 73 300 results of
which 1 fit the inclusion criteria
• Google search for 'burns algorithms prehospital’ of which 4 were utilized.
General burn assessment: Patient Extrication
 1° - Superficial / Minor  Ensure self and patient safety

START
 Remove patient from burn source
 2°- Moderate
 Remove any restrictive clothing and
 3° - Major jewellery
%TBSA ass. not included in superficial  Cool burn with running tap water (8-15 ℃)
burns ≥ 20 min℃[1]. Hydrogel dressings alt. only if
no H2O available[1][2]
Primary Survey Secondary Survey
• Airway damaged? Management
• Inhalation injury?
Detailed Burn Assessment:
 Airway  Carbonaceous sputum • Early intubation  1°, 2° or 3° - assess %TBSA via
 Closed space fire
YE • High flow O2 • Rule of 9’s or Palm method
 Respiratory distress – hoarseness/stridor • Rule of 8’s – infants <10 kg


Cough / Dyspnoea
Singed facial / nasal hairs
S  Minor: <10% adults, <5% paeds/elderly, <2% for full
NO  Upper airway oedema[16] thickness
YE Shock Management:
 Moderate: 10-20% adults, 5-10% paeds/elderly, 2-5% for
 Breathing • Oxygenation – all burns victims full thickness
receive 100% O2 S  20 ml/kg IV bolus
 Major: >20% adults, >10% paeds/elderly, >5% for full
Ringer's lactate[8] thickness[19]
• Assess for CO poisoning [16]

Fluid resuscitation:
• Insert IV
 Continue with Parklands IV fluid administration
 Circulation • Vitals – Glucose, BP, SATs, Temp
• Signs of hypoperfusion? Parklands Formula: Pain Management:
4 ml/kg x %TBSA x weight  IV administration:
(kg)  Morphine – 0.1 mg/kg[1]
• Trauma resus = total/2  Ketamine – 0.25 – 0.5 mg/kg[10][8]
• Assess altered mental
 Disability status/consciousness – NO Wound care:
1/2 1/2
CO/CN poisoning  Wrap wound in cling wrap

• Avoid hypothermia – remove wet

clothing,, cover with blankets, TRANSFER TO EC / BURN CENTRE
 Exposure warm IV fluids[12] First 8 Followin  Record cause, mechanism and timing of injury
• Evaluate for transfer – Tygerberg hours g 16
 What first aid was given?
or Red Cross hours
[5]  Other risk factors
 CONSIDERATIONS

• Less complex fluid resus guideline – Pre-Hospital Initial Fluid Therapy

Estimate in Early Nasty Burns (PHIFTEEN B, 15-B) estimates the initial
hourly fluid for adults:
• ≥ 50 kg to be:
• 15 ml x BSA (to the nearest 10%)
• If more than 100 kg add 200 ml/h

• CPG states Morphine (opiod) analgesic administration, 2 sources state

moderate evidence with regards to combination use of Ketamine and
Morphine.
THANK YOU
REFERENCES:

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